Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia.

Autor: Napolitano N; Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Jalal K; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., McDonough JM; Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Monk HM; Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Zhang H; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Jensen E; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Dysart KC; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Kirpalani HM; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Panitch HB; Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2019 Jul; Vol. 54 (7), pp. 1045-1051. Date of Electronic Publication: 2019 Apr 04.
DOI: 10.1002/ppul.24328
Abstrakt: Rationale: Infants with severe bronchopulmonary dysplasia (sBPD) and airway obstruction may develop dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP i ), which impairs patient/ventilator synchrony.
Objectives: To determine if PEEP i is present in infants with sBPD during spontaneous breathing and if adjusting ventilator PEEP improves patient/ventilator synchrony and comfort.
Methods: Interventional study in infants with sBPD. PEEP i measured by esophageal pressure (Pes) and pneumotachometer, during pressure-supported breaths. PEEP i defined as the difference between Pes at start of the inspiratory effort minus Pes at onset of inspiratory flow. The set PEEP was adjusted to minimize PEEP i . "Best PEEP" was the setting with minimal wasted efforts (WE), an inspiratory effort seen on the Pes waveform without a corresponding ventilator breath. FiO 2 and SpO 2 measured pre- and post-PEEP adjustment. Sedation requirements evaluated 72 hours preprocedure and postprocedure.
Results: Twelve infants were assessed (gestational age, 24.9 ± 1.4 weeks; study age, 48.8 ± 1.5 weeks, postmenstrual age). Mean baseline ventilator PEEP was 16.4 cm H 2 O (14-20 cm H 2 O). Eight infants required an increase, one, a reduction, and three, no change in the set PEEP. For the eight infants requiring an increase in set PEEP, there was an 18.9% reduction in WE and a reduction in FiO 2 (0.084  ±  0.058) requirements in the subsequent 24 hours. Conditional sedation was reduced in five infants postprocedure. No adverse events occurred during testing.
Conclusion: PEEP i is measurable in infants with sBPD with concurrent esophageal manometry and flow-time tracings without the need for pharmacological paralysis. In those with PEEP i , increasing ventilator PEEP to offset PEEP i improves synchrony.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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